title: Mucormycosis: a rare fungal infection in tornado victims.
abstract: This article reviews four immunocompetent patients who developed a rare fungal infection, mucormycosis, secondary to multiple traumatic injuries sustained during an EF-5 tornado in Joplin, MO. Commonly found in soil and decaying organic matter, mucorales are fungi associated with soft tissue and cutaneous infections. Onset of this fungal infection can occur without clinical signs, presenting several days to several weeks after injury, delaying diagnosis. A multidisciplinary treatment approach including aggressive antifungal therapy and aggressive surgical debridement is critical. This diagnosis should be considered in all patients presenting with injuries sustained from high-velocity embedment of debris such as natural disasters or explosions. We present four cases of mucormycosis, species Apophysomyces trapeziformis. Data reported includes predisposing factors, number of days between injury and diagnosis of mucormycosis, surgical treatment, antifungal therapy, outcomes, and potential risk factors that may have contributed to the development of mucormycosis.
authors.affiliation: From the Division of Trauma and Burn Research, Mercy Hospital, Mercy Medical Research Institute, Springfield, Missouri.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Austin
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Finley
authors.forename: Debbie R
authors.initials: DR
authors.lastname: Mikkelson
authors.forename: Brian
authors.initials: B
authors.lastname: Tibbs
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods*; D064891:Disaster Victims / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007121:Immunocompetence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008923:Missouri; D009091:Mucormycosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D017695:Soft Tissue Injuries / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D015996:Survival Rate; D055869:Tornadoes; D016896:Treatment Outcome; D014946:Wound Infection / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy
chemical_list: D000935:Antifungal Agents